Epilepsy Talk

Prescription Switching. Do You Know What You’re REALLY Getting? | February 23, 2020

How many times have you had a prescription switched without your knowledge or permission?

Not just switched to a generic version of the prescribed drug, but to a different drug altogether.

Yet the practice of swapping out medications is perfectly legal in most states.

It’s called “therapeutic substitution” and it happens when a patient is switched from to a cheaper medication in the same class of drugs.

With therapeutic substitution, a pharmacist substitutes a chemically different drug for the drug that the physician actually prescribed.

The drug substituted by the pharmacist belongs to the same pharmacologic class or to the same therapeutic class.

However, since the two drugs have different chemical structures, there are potentially adverse outcomes for the patient. 

(Sometimes you can even tell by the shape or color of the pill!)

The move may be from a name brand to a generic, but it also can be to a different medication entirely.

And why are the pharmacies switching you?

To save money, of course.

But then there are the insurance companies — putting pressure not only on the pharmacies but on doctors, too.

“Pharmacies are directly reimbursed by insurance companies and make more money from generics even though the sticker price for brand-name drugs is higher,” says Dr. Robert Reneker, an urgent care physician.

“I’ve had pharmacies tell me a drug isn’t on the formulary when I’ve already checked with the insurance company and know that it is. The switch to a cheaper substitute is motivated purely by profit.”

The one benefit for you may be smaller co-pays.

But two-thirds of people who reported having meds switched in a National Consumers League survey said they weren’t consulted.

Of those, 40 percent said the new drug was not as effective, and a third said it had more side-effects.

“It’s not okay for your insurance company or pharmacist to change your drugs without your knowledge,” says NCL Executive Director Sally Greenberg.

But, unfortunately, therapeutic substitution is likely here to stay — meaning you need to be on the lookout to make sure you’re not harmed by the practice.

Some suggestions:

Ask your doctor to write “DAW” on the prescription, which stands for Dispense As Written.

Have your pharmacist put a note in your records that says you don’t want any prescription switched without your approval.

If you’ve noticed the pharmacy has switched your medication anyway, get your doctor’s office on the phone to explain why you need the specific drug that was prescribed.

If your prescription HAS been switched, you should ask your pharmacist these questions:

Is this the exact drug my doctor prescribed?

Will this switch affect my health?

Why are you switching my prescription?

Have you notified my doctor of this switch?

Will the new drug work better?

How will I know if it does or doesn’t?

Are side-effects different from those associated with the original prescription?

How will it interact with other medications or supplements I might be taking?

An Epilepsy Action survey showed that of those given alternative versions of their usual anti-epileptic drugs in one year, almost a quarter (23 per cent) said their epilepsy got worse. Most of these people reported an increase in the number of seizures they had.

Almost half (43 per cent) of those who spoke to their pharmacist were told that there was nothing to worry about and that all versions were the same. One in seven (15 per cent) found that pharmacists were not aware of the issue.

In its survey, Epilepsy Action asked people whether they spoke to their doctor after having been given a different version of their AED. Almost a third (31 per cent) were told there was nothing to worry about. Nearly a quarter (22 per cent) were told all brands were the same and one in six (16 per cent) found their doctor was not aware of the issue.

One good piece of news. Restricting substitution of epilepsy brand-name drugs has been filed in eight states.

(Connecticut, Georgia, Iowa, Massachusetts, Michigan, Minnesota, New Jersey and New York). Let’s hope more states follow their directive.

NOTE: This letter has been created by the Epilepsy Foundation to make explicitly sure that no substitutions are made to your prescription without full consent by you and your doctor.

You might want to make a copy of it for your files.

Dear Pharmacist: 

Thank you for providing me with the valuable service of filling my needed prescriptions. The purpose of this letter is to let you know that I have epilepsy and it is vital that I receive the same medication from the same manufacturer monthly in order to maintain the expected level of seizure control and side-effects.

Please ensure that no changes are made to my medications, including a change in manufacturer, without prior consent from my physician and myself. Please note this request in my file. To assist you, I have listed below the name, manufacturer, and dosage of the medications I am currently taking.

Thank you very much,

Your Signature________________________________________

Today’s Date__________________________________________

Your Printed Name_____________________________________

Phone Number________________________________________

Physician’s Name______________________________________

Phone Number________________________________________

Brand Name__________________________________________

Generic Name_________________________________________

Manufacturer _________________________________________

Dosage ______________________________________________









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  1. Thank you for this article. I noticed that I do get different brands of AEDs. I will start monitoring/watching out to see if this has an effect on my Seizures.

    Liked by 2 people

    Comment by prasadmok — February 23, 2020 @ 8:38 PM

    • Check the size and color of the tablet. Then you might even want to check the number of tablets.

      You might inquire if you notice any changes. Usually it’s a change in manufacturer.

      Liked by 1 person

      Comment by Phylis Feiner Johnson — February 24, 2020 @ 6:47 AM

      • I never realized we could stick or even had to opportunity to stay with the original maker of our medications!! It was never presented to me. Thank you

        Liked by 1 person

        Comment by Kathy S.B — February 24, 2020 @ 9:33 AM

    • I noticed it sure had a negative effect on me, my body and my head in a negative fashion badly!!!!!!! Even the new vitamins the pharmacist tried to put me on causes me to break out in more hives and another rash!! I quickly stopped the vitamins and now have to go back to the old ones!!!!! And that was just a combination vitamin of calcium and vitamin D!

      Liked by 1 person

      Comment by Kathy S.B — February 24, 2020 @ 9:31 AM

    • I do notice that the color of the tablets and the manufacturer of the same drug – especially Levetiracetam/Keppra being different. Since I have almost daily Seizures and they vary in intensity was not keeping track. I will ask my Neurologist to make sure and will keep track of any changes when the brands change. Thank you for the really helpful information.

      Liked by 2 people

      Comment by prasadmok — February 24, 2020 @ 8:16 PM

      • I contacted my Neurologist regarding drug manufacturers and below was his response.
        “Rarely, yes, but it is quite unusual.

        The FDA requires that the different brands produce blood levels within 20% plus-minus of each other. That degree of variability is within usual biological variation. Dilantin is an exception to this rule, but for the other drugs, I recommend the cheapest generic.

        A few individuals say that the brand name drug stops their seizures better, and I take their word for it and write for them to get the brand name. They may have to pay a lot more.”

        Liked by 2 people

        Comment by prasadmok — March 3, 2020 @ 7:45 PM

      • With generic drugs, 80% is the formulary and 20% is an unknown “filler”.

        So, it’s anybody’s guess what you’re really getting.

        As for Dilantin, it’s as old as dirt. (When I was first diagnosed, the only thing available was Dilantin or Phenobarbitol. Goes to show you how old I am!)

        But I don’t think there’s much money to be made from Dilantin. Whether it’s brand-name or off label.

        Liked by 1 person

        Comment by Phylis Feiner Johnson — March 3, 2020 @ 8:02 PM

      • I take other drugs as well as Phenobarbital. I have been trying to get off Phenobarbital since it’s addictive. Unfortunately everytime I reduce the amount I end up with Grand mals. That seems to be the only drug that reduces my Grand mals 😦

        Liked by 2 people

        Comment by prasadmok — March 3, 2020 @ 8:50 PM

  2. Thank you Phylis 😊. Makes me wonder if that applies in Canada as well? If so, BOY DID MY PHARMACY EVER MESS UP BADLY!!!!! As your well aware. Makes me wonder if that’s why I had the grandmal seizure that caused my concussion and now hyponatremia!! Or if that’s why I had to sign a letter at my doctors office just to get my medications? It was in my doctors and pharmacy’s file “NO SUBSTITUTIONS” and somehow over looked by my pharmacist. I caught it myself and then brought to my pharmacist’s and doctors attention. But I was on generic medications too long it already caused hyponatremia and somehow I can’t seem to be able to get any movement even by any lawyer!! And I can’t partake in lawsuits in a different country other than Canada. So now I just hope I can catch my breath long enough to try another medication whenever I get back into a neurologist again!! I greatly appreciate your lesson. I now take pictures of the prescription before I even leave the doctors office and as soon as I pick up my refills of the prescriptions afterwards.

    Liked by 1 person

    Comment by Kathy S.B — February 23, 2020 @ 9:42 PM

  3. I think it happens universally.

    No, I don’t think a lawsuit wold be successful. “You can’t fight City Hall.”

    And yes, it’s brilliant to take pictures of the prescription. It’s a great permanent point of reference.

    Smart lady!

    But I guess you learned the heard way. 😦

    Liked by 1 person

    Comment by Phylis Feiner Johnson — February 24, 2020 @ 6:54 AM

  4. Dear Phyllis,
    Thank you for “EpilepsyTalk.” It is a real service the Epilepsy community and a model for helpful and accessible info for patient advocates of every stripe.
    You rock!
    With admiration,
    Lisa Lindahl
    Author, “Unleash The Girls”
    and, OBTW, person with epilepsy

    Liked by 2 people

    Comment by Lisa Z Lindahl — February 24, 2020 @ 9:00 AM

  5. Once, with my then-doctor’s approval but without my knowledge, the pharmacy switched prescriptions. Because the previous prescription had run out, there was no way to change gradually from one to the other. I was bed-ridden for the better part of a week, in considerable pain. When I told the doctor, he just shrugged. “It doesn’t work for everyone.”

    Liked by 1 person

    Comment by HoDo — February 24, 2020 @ 11:23 AM

  6. Once, with my doctor’s approval but without by knowledge, the pharmacy switched prescriptions. Because the previous prescription had run out, there was no way to switch gradually from one Rx to the other. I was bed-ridden for the better part of a week, in considerable pain. My doctor just shrugged. “That one doesn’t work for everybody.” Sometimes there is no “care” in “health care.”

    Liked by 2 people

    Comment by HoDo — February 24, 2020 @ 11:28 AM

  7. What a real winner that Dr. is, Hodo! Jerk is a good word Phylis. I’m very obsessive about my meds, for good reason ( see Phylis post). It’s happened several times but what’s happened even more often is, changing name of drug company. It does make a difference at least for me but
    Dr.s and Pharmacists are very nonchalant about those side effects..
    so, I’m on their cases and still, wrong company occurs, thus med delay as they search for availability.
    very frustrating……..

    Liked by 2 people

    Comment by skolly9 — February 24, 2020 @ 8:42 PM


    Liked by 1 person

    Comment by Kathy S.B — February 24, 2020 @ 9:41 PM

  9. Sorry Phylis and you ALL

    Liked by 1 person

    Comment by Kathy S.B — February 24, 2020 @ 9:43 PM

  10. Sure Kathy, it’s easier for a Dr. or Pharmacist to put the blame on let’s say “the hysterical female with epilepsy ” or god “fits” than spend a bit more time staying on the same ongoing drug company,

    everyone is overworked, I get it, but we end up suffering with a nasty seizure, don’t we?

    Liked by 2 people

    Comment by skolly9 — February 24, 2020 @ 10:41 PM

  11. I think that doctors look at us as compliant beings. Hysterical would be implying that we’re people, rather than the nameless, faceless entities that we are.

    Profit center? Maybe. Suffering patient? I don’t think so.

    Borrowing a phrase from HoDo, what happened to the “care” in health care? Is everyone too busy to care? Or scared? Or selfish?

    Perhaps I’m ranting on because I feel we’re discredited for what we say and do, by the very people who are theoretically there to help us.

    Liked by 1 person

    Comment by Phylis Feiner Johnson — February 24, 2020 @ 11:41 PM

  12. I hate to say this but I ALSO AGREE WITH HODO!! And yes Dilantin is THE WORST AS WELL!! But it’s almost like the better of both evils for one person to take or handle when it just comes to losing a tooth or losing yourself in the pain of epileptic medications that not even we can explain or remember

    Liked by 1 person

    Comment by Kathy S.B — February 25, 2020 @ 1:14 AM

  13. I have to wonder what’s in the “filler” and how it might affect a person.

    Also, although veterinarians prescribe medications for animals by the weight of the critter, doctors of humans tend not to take size into consideration. That 20% difference may mean one thing to a 250-pound guy, and quite another to a 98-pound senior.

    So the idea that two versions of the same drug are “identical” is open to debate to those of us whose experiences say not. We need a good, clear definition of “identical” each time our meds are switched. And more thoughtful doses.

    Liked by 2 people

    Comment by HoDo — March 4, 2020 @ 7:54 AM

    • You make a good point here related to weight of a person and the dosage. I don’t think physicians take that into consideration.

      Liked by 2 people

      Comment by prasadmok — March 4, 2020 @ 9:11 AM

    • I agree with you HoDo.

      When I first started taking Dilantin, I was 12 and weighed 120 lbs. Yet I was given an “adult” dose, without any consideration to my age and size.

      It turned out that it was toxic and I went into a “deep sleep” for three days.

      Liked by 1 person

      Comment by Phylis Feiner Johnson — March 4, 2020 @ 9:28 AM

  14. The funny part is our doctors, neurologists and pharmacists should all be aware of how WE AS EPILEPTICS MAY APPEAR BIG AND TOUGH YET WE CAN VERY QUICKLY FALL LIKE A MOUNTAIN VERY FAST BECAUSE OF THEIR TRUE NEGLECT OR WANTING TO SINCERELY CARE ABOUT US AS A HUMAN LIVING BEING WITH HUSBANDS/WIVES/CHILDREN AND FAMILIES AND FRIENDS!!!!! So if anything happens to us WHAT ABOUT OUR LOVED ONES?!!!!!!! It TRUELY is not our fault if we can’t take anything BUT BRAND NAME MEDICATIONS I PROMISE!! They should have caught that from all of the rashes and infections I get EVERYTIME the pharmacist gives me a generic medications!! Funny how NOW EVEN MY HUSBAND AND FRIENDS (who pick up my medications for me) ALSO TAKE PICTURES RIGHT AT THE PHARMACISTS COUNTER BEFORE LEAVING THE PHARMACY!!!!!!! Sorry for the rant

    Liked by 1 person

    Comment by Kathy S.B — March 6, 2020 @ 9:28 PM

  15. Ironically as I mentioned before the doctor who was able to finally properly diagnose me with epilepsy and the doctor who ended up being my long term doctor both had daughter who were epileptics. On one hand I was a bit surprised when one of the doctors wife’s asked me to speak with their epileptic daughter because she was having problems with her seizures and stigma from classmates and some teachers. I didn’t quite know what to say but I tried. Finally I invited her to come to one of my hockey practices and and then hockey games and told her she could take skating lessons privately. That if I could do it so could she!! Then she asked me if I did anything else and I told her “yes I do. I play baseball, coach baseball, play basketball, volleyball, track and field, go to rodeos and ride horses and I can (but don’t) drive. I was raising my brother at the time and he seen her in school and told me what happened to her at school. He was crying as he told me what the other kids did and said about her and left and came home. I told him “help her and be there for her. You know how to help her. Be her friend and care for her. One day she will thank you for it and never forget you!!”. He did and ended up being her escort to her HighSchool graduation and his friends also began to think twice and come around as well. All it takes is one person to believe in you!!!!!!! So you can BELIEVE IN YOURSELF!! 😊🦅💗

    Liked by 1 person

    Comment by Kathy S.B — March 6, 2020 @ 10:55 PM

    • You do wonderful things for those you love as well as those you don’t even know.

      I love the fact that you were able to empower her.

      And that your brother took the time and care to take her to the prom.

      That’s real empathy. Something you never forget.

      And a shining example of support.

      Liked by 1 person

      Comment by Phylis Feiner Johnson — March 7, 2020 @ 9:11 AM

      • That you Phylis 😊, but I think that fell on both me and my brother’s shoulders as more of a humanistic compassionate way of supporting those that just need little support and friend 😊🦅💗💝. I sure miss that doctor still!!!!! And his wife (who used to be a nurse also retired) so they could move in order to help their daughter continue to move forwards with her schooling as well. But I still have the very first doctor who diagnosed me as a little girl that lives in my little town her now. In fact he’s apart of my religious congregation 🙏🏼🦅😇💗. Thank god I live in a tiny town with 28 streets and 8 avenues 😘💗. It’s the new pharmacists that come to our little town to practice that neglect to do their due diligence to ensure they properly read our files properly and then we pay they price in every possible way later that makes the medical personal look and ourselves look bad and that is very upsetting to me!!!!! I literally had to go and tell my retired doctor to please come with me to my appointment to clarify my medication situation and IT STILL BOILED DOWN TO THE PHARMACIST NOBODY ELSE!!!!!!! As for my doctors daughter apparently now she has diabetes as well and that was so HURTFUL AND SCARY ST THE SAME TIME!!

        Liked by 2 people

        Comment by Kathy S.B — March 7, 2020 @ 9:29 AM

      • Do you think the new pharmacists don’t know? Or they’re so overloaded with work that they don’t even care?

        See: At Walgreens and CVS, Complaints of Medication Errors Go Missing


        Liked by 1 person

        Comment by Phylis Feiner Johnson — March 7, 2020 @ 9:34 AM

      • Yes I have even had medications or pill packs NOT FULLY PROPERLY FILLED AT TIMES EITHER!!!!!!! That is where the pictures come in handy. Too bad the pharmacists DON’T PAY ATTENTION BECAUSE ONE DAY IT COULD BE THEMSELVES OR THEIR LOVED ONES IN OUR SHOES!!

        Liked by 1 person

        Comment by Kathy S.B — March 7, 2020 @ 10:06 AM

  16. I chuckled this last time when I told them “lol you tell me I can’t take this or that when for centuries that’s what my people took to help ourselves if we were sick!! If you can’t fill it properly or don’t have time to look back in your files (DOWNSTAIRS IN THE HUGE FILING CABINETS) then tell me now and I’ll look into it myself, but don’t ever tell us we can’t because then we will find a way!!”. Secretly I thought to myself “gee I wonder what my great grandparents would say to me now? GO BACK TO YOUR ROOTS!!!!!!!”. 😘🙏🏼🦅😇🙏🏼💕😘

    Liked by 1 person

    Comment by Kathy S.B — March 7, 2020 @ 10:12 AM

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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

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